Popliteal Artery Entrapment Syndrome in Children: Experience With Four Cases of Acute Ischaemia and Review of the Literature.

OBJECTIVE: Popliteal artery entrapment syndrome (PAES) is an uncommon anatomical anomaly, frequently described in adults. The most common symptom is claudication. Acute limb ischaemia (ALI) in children is rare, but it may evolve and lead to limb loss or lifelong complications. Clinical and surgical experience of PAES in children is reported. Data from the literature are analysed in order to assess the severity of this disease and to identify the factors characterising the diagnosis and the outcome of treatment in paediatric patients. METHODS: Four children (aged 7-16 years) were referred with ALI due to PAES. Among the 439 articles reporting cases of PAES, 55 patients under 18 years of age were the focus. The PAES cases were classified according to the Love and Whelan classification modified by Rich. RESULTS: Data from 79 children (106 limbs, 27 bilateral PAES) were collected and analysed. Type I PAES was present in 41 (39%), Type II in 23 (22%), Type III in 24 (23%), Type IV in 12 (11%), and Type V in two (2%) limbs. A functional PAES was present in one patient bilaterally. In two cases, the type of PAES was not reported. Claudication occurred in 68 cases (64%), and ALI in 19 (18%). In 60 cases (57%), revascularisation with or without myotomy was required; myotomy alone was performed in 41 cases (39%). CONCLUSIONS: Symptomatic PAES in children should be considered a severe condition requiring urgent investigation in order to avoid any delays in the treatment. Early diagnosis and treatment are essential to prevent serious complications. The long-term outcomes of surgical treatment with the correction of the anatomical anomaly and vascular reconstruction are satisfactory with a low complication rate.

[Vascular type of Ehlers-Danlos syndrome: a rare cause of spontaneous pseudo-aneurysms]. / Syndrome d'Ehlers-Danlos de type vasculaire : une cause rare de faux-anévrismes artériels spontanés.

We report a case of a 20-year-old-man who was admitted to our hospital through the emergency room for a swelling of the right thigh, which had appeared spontaneously without fever. The physical exam was highly suggestive of a vascular mass. The arterial CT scan of the right lower limb revealed a pseudo-aneurysm of a branch of the deep right femoral artery. The diagnosis of vascular type of Ehlers Danlos syndrome was established on clinical criteria. The successful management was surgical by the excision of the pseudoaneurysm and the ligation of the feeding branch that supplied the pseudoaneurysm. The postsurgical follow-up was uneventful and the clinical course was smooth with no further complications.

[Limb traumatic arteriovenous fistula: experience of 26 cases]. / Fistules artérioveineuse post-traumatiques des membres : expérience de 26 cas.

INTRODUCTION: Posttraumatic arteriovenous fistulas are not a rare event in military facilities during periods of armed conflicts, but are seldom seen in the civilian health care system. PATIENTS AND METHOD: We report our approach to the management of 26 cases of posttraumatic limb arteriovenous fistulas colligated from 1996 to 2006. RESULTS: The main cause of our posttraumatic arteriovenous fistulas is the penetrating traumatism. Arteriography was the mostly used imaging exploration. The treatment was surgical for 24 patients. One case of thrombosis was reported. CONCLUSION: Our series of posttraumatic fistulas is characterized by a particularly high rate of penetrating trauma, in which case intervention is the rule. Our study shows that, in our experience, surgical treatment is still a safe and efficient therapeutic attitude.

[Acute lower limb ischemia revealing acute leukemia. Case report and review of the literature]. / Ischémie aiguë du membre inférieur révélant une leucémie aiguë. A propos d'un cas et revue de la littérature.

Large vessel thrombosis is a very rare clinical presentation of acute leukemia which is usually revealed by hemorrhagic complications or thrombosis of small vessels. We present here the case of a patient with previously undiagnosed acute myeloid leukemia who was referred to our hospital with symptoms of acute ischemia of the left lower limb. Occlusion of the left popliteal artery due to a leucostasis was noted and successfully treated with emergency surgical thromboembolectomy and chemotherapy.

[Coeliac trunk aneurysm revealing Behçet disease (2 case reports)]. / Anévrisme du tronc coeliaque révélant la maladie de Behçet. A propos de deux cas.

The Behçet's disease is a vasculitis of an unknown origin. Vascular inflammatory lesions predominantly affect veins, potentially leading to superficial or deep thrombophlebitis. Arterial involvement is rare, mainly aneurysms. We display two case reports of patients where Behçet's disease is revealed by celiac trunk aneurysm. The symptoms are nonspecific. Ultrasound Doppler and angioscan are a key to the diagnosis. The two patients received medical and surgical treatment. By these two case reports, we insist that the diagnosis of Behçet's disease should be evoqued in any young patient with arterial aneurysm.